There’s quite a bit of literature out there outlining the dangers of FCR, particularly with unmutated CLL and the potential for richters transformation. This seems somewhat hazardous information.
I would have to disagree with what you say is not required at diagnosis; or at least some of these tests ought to be done AS SOON AS POSSIBLE after CLL is diagnosed! I had a biopsy and fish testing right away when CLL was suspected. CLL/ SLL was suspected from a CT scan (!) after a car accident. So right away, the doctor knew what lymph nodes were involved through my body, and how enlarged they were, whether they might be pressing on organs. Then the surgical biopsy made the firm diagnosis. A surgical biopsy was determined to be the best, most accurate course as needle biopsies had failed to show my thyroid cancer in the past. The biopsy and fish testing then revealed my risk category (p17 del, tp53 mutation, IGHV unmutated status, etc.) which also guided treatment choices and informed the doctor that time to first treatment might be considerably shorter than for most. It was 8 months, and if I had changed oncologists sooner; treatment would have begun sooner. So much information gained about risk status, progression, treatment options when these tests are completed right away. The earlier the better.
No need for a CT scan to diagnose though and typically for lymph nodes, the visual or inspection of your organs will suffice. We as patients tend to thing in terms of information and answers…which all those test provide. However, what this doc is indicating is that because of the treatments available that those tests are not as deterministic these days.
