YEARS Algorithm Safely Rules Out Pulmonary Embolism in Cancer Patients, Suggests Study
Netherlands: In patients with active cancer and suspected pulmonary embolism (PE), the YEARS diagnostic algorithm was as safe as a CTPA-only strategy for excluding PE. Importantly, the YEARS approach avoided the need for CTPA in 22% of patients, potentially reducing radiation and contrast exposure while maintaining diagnostic safety.
The findings come from the Hydra randomized clinical trial, published in JAMA by Bram Akerboom, Department of Medicine–Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands, and colleagues. The study addressed uncertainty around using YEARS in patients with cancer, a population in whom current guidelines generally recommend proceeding directly to computed tomographic pulmonary angiography (CTPA).
The open-label, investigator-initiated noninferiority trial was conducted between August 2019 and August 2025 across 21 hospitals in the Netherlands, Italy, Switzerland, Belgium, France and Spain. It included patients with active cancer who presented with suspected acute PE.
A total of 698 patients were randomized, with 352 assigned to the YEARS strategy and 346 to CTPA-only management. Participants had a median age of 65 years, and 60% were women. PE was confirmed at baseline in 104 patients (15%).
Under the YEARS strategy, clinicians assessed three clinical criteria, measured D-dimer levels, and used these findings to determine whether CTPA was required. The primary endpoint was symptomatic venous thromboembolism or possible PE-related death within 90 days among patients in whom PE had initially been ruled out.
The following were the key findings:
- The 90-day diagnostic failure rate was 1.8% with the YEARS algorithm versus 5.5% with CTPA alone, meeting the prespecified criteria for noninferiority.
- The absolute risk difference in the per-protocol analysis was −3.7 percentage points, favoring the YEARS strategy.
- In the intention-to-diagnosis analysis, the absolute risk difference was −2.6 percentage points, confirming that YEARS was not inferior to CTPA-only management for safely ruling out PE.
- The YEARS approach avoided CTPA in 77 of 352 patients (22%), potentially reducing unnecessary radiation and contrast exposure.
- No significant difference was observed between the two strategies in the proportion of negative CTPA results.
The authors noted several limitations. Patients with a life expectancy of less than three months were excluded, potentially limiting applicability to this group. The open-label design may also have introduced bias, although outcome events were independently adjudicated by investigators blinded to treatment allocation. The study was not sufficiently powered for subgroup analyses according to cancer type or stage.
Overall, the findings indicate that the YEARS algorithm can safely exclude PE in selected patients with active cancer while avoiding CTPA in approximately one in five patients. The researchers said the results support YEARS as an alternative diagnostic strategy, although further evidence may be needed across different cancer populations.
Reference:
Akerboom B, Martens ESL, Stals MAM, et al. YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism in Patients With Cancer: A Randomized Clinical Trial. JAMA. 2026;336(8):655–663. doi:10.1001/jama.2026.10676
Next Story