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Electron Microscopic Grading of Doxorubicin Cardiotoxicity

Description

Ultrastructural evaluation of an endomyocardial biopsy can be used to evaluate the severity of myocyte damage following doxorubicin therapy. Patients with moderate to severe damage are at risk for congestive cardiomyopathy and should not receive additional chemotherapy with doxorubicin.


Ultrastructural Findings

Grade

no change from normal

0

isolated cells (< 5% of total number of cells) showing early myofibrillar loss and/or distended SER

1

5 - 30% of total number of cells showing marked myofibrillar loss and/or cytoplasmic vacuolization

2

> 30% of total number of cells showing cell damage, with most showing a total loss of contractile elements, loss of organelles, mitochondrial degeneration and/or nuclear degeneration

3

 

where:

• SER = sarcoplasmic endoplasmic reticulum

 

For patients being followed serially, intermediate grades midway between Grades 1 and 2 (termed "2A") and Grades 2 and 3 (termed "2B") can be used.

 


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Specialty

ICD-10