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Individuals with MBL seen at Mayo Clinic (2002\u20132019) were retrospectively divided into three cohorts based on imaging studies within 1\u2009year of diagnosis: no imaging studies (Cohort A); imaging with no evidence of lymphadenopathy\/splenomegaly (Cohort B); imaging with evidence of lymphadenopathy\/splenomegaly (Cohort C). We compared baseline characteristics, TTFT and OS across the MBL cohorts to a cohort of individuals with small lymphocytic lymphoma (SLL). A total of 1078 patients were included: 640 with MBL and 438 with SLL. Compared to Cohort B, individuals in Cohort C were more likely to have unmutated immunoglobulin heavy chain variable region (<jats:italic>IGHV<\/jats:italic>) (43% vs. 25% <jats:italic>p<\/jats:italic>\u2009=\u20090.016), high\u2010risk fluorescence in\u00a0situ hybridization (FISH) (del17p and del11q in 15% vs. 4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.038) and higher expression of CD38 (31% vs. 16%; <jats:italic>p<\/jats:italic>\u2009=\u20090.011). After adjusting for sex and CLL\u2010International Prognostic Index (IPI), lymphadenopathy\/splenomegaly was associated with a shorter TTFT (hazard ratio [HR]\u2009=\u20092.04, 95% confidence interval [CI]: 1.02\u20134.04, <jats:italic>p<\/jats:italic>\u2009=\u20090.042) but not OS (HR\u2009=\u20091.09, 95% CI: 0.62\u20131.92, <jats:italic>p<\/jats:italic>\u2009=\u20090.775). Lymphadenopathy\/splenomegaly on imaging in individuals with high\u2010count MBL is associated with a more unfavourable risk profile and shorter time to first CLL\u2010directed therapy.<\/jats:p>","DOI":"10.1111\/bjh.70009","type":"journal-article","created":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:48:56Z","timestamp":1752626936000},"page":"860-868","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The role of imaging studies in predicting time to first treatment and overall survival in high\u2010count monoclonal B\u2010cell lymphocytosis"],"prefix":"10.1111","volume":"207","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1666-5261","authenticated-orcid":false,"given":"Samuel","family":"Kosydar","sequence":"first","affiliation":[{"name":"Department of Medicine Mayo Clinic  Rochester Minnesota 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