YEARS Algorithm for Evaluating PE in Patients With Cancer

Among adults with active cancer undergoing evaluation for possible acute pulmonary embolism (PE), a diagnostic pathway built around the YEARS algorithm met the study’s noninferiority standard when compared with a computed tomographic pulmonary angiography (CTPA)-only strategy. The findings come from the randomized Hydra trial, published in JAMA.

Investigators randomized 698 patients with suspected acute PE at 21 hospitals in Europe. Participants received diagnostic management using either YEARS or the CTPA-only approach. YEARS combines an assessment of predefined clinical criteria with D-dimer cutoffs to determine which patients require CTPA, whereas all participants in the comparator group underwent CTPA.

The primary outcome comprised symptomatic venous thromboembolism or possible PE-related death within 90 days among patients whose initial evaluation excluded PE. In the per-protocol population, the outcome was recorded in 5 of 282 patients assigned to YEARS and 15 of 273 assigned to CTPA only. The absolute risk difference was −3.7% (99.9% CI, −8.8% to 1.4%), satisfying the final 2.6% noninferiority margin.

The protocol initially specified a 2.0% margin. Investigators recalculated the margin under prespecified procedures as event data accrued, resulting in a 2.6% margin for the final analysis. Recruitment ended after an interim analysis demonstrated noninferiority, and follow-up was completed for patients who had already been randomized.

The YEARS pathway also decreased the need for CTPA. Of the 352 patients assigned to that strategy, 77, or 22%, completed the diagnostic evaluation without undergoing CTPA. The investigators concluded that YEARS provided safety comparable to CTPA-only management for excluding PE in patients with active cancer while avoiding CTPA in a meaningful proportion of patients.

Sources: 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. Published online July 12, 2026. doi:10.1001/jama.2026.10676