Cancer, fertility and pregnancy: ESMO clinical recommendations for diagnosis, treatment and follow-up.

The diagnostic work-up should include a thorough physical examination, including the pelvis, breasts, lymph nodes, skin and should limit unnecessary exposure to ionizing radiation. Fine needle aspiration, core needle or open excisional biopsies are safe to perform. Chest X-ray and mammography with abdominal shielding and ultrasonic examinations are the cornerstone of a basic staging, supplemented by magnetic resonance imaging (MRI) scans when needed [IV, B]. Gadolinium should not be administered during the first trimester of pregnancy [V, D]. Computerized tomography (CT) or radioisotope studies should be avoided.