YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism in Patients With Cancer: A Randomized Clinical Trial.

Summary

In a multicenter randomized noninferiority trial of 698 cancer patients with suspected PE, the YEARS algorithm was as safe as CTPA-only management and enabled avoidance of CTPA in 22% of patients. The 90-day thromboembolic event rate after PE exclusion was lower in the YEARS group in per-protocol analysis, meeting noninferiority criteria.

Key Findings

• Noninferiority met: 90-day symptomatic VTE/PE-related death after PE exclusion was 1.8% (YEARS) vs 5.5% (CTPA-only) in per-protocol analysis.
• CTPA was avoided in 22% of patients managed with the YEARS algorithm.
• No difference in the proportion of negative CTPA between groups (P=.93).
• Central blinded adjudication and intention-to-diagnosis analysis confirmed robustness.

Clinical Implications

For cancer patients with suspected PE, applying the YEARS algorithm can safely reduce CTPA utilization and streamline diagnostic workflows. Implementation may lower contrast-related risks and resource use without increasing missed VTE events.

Limitations

• Open-label design may introduce management biases
• Heterogeneity of cancer types and treatments may affect generalizability; no reduction in negative CTPA proportion

Future Directions

Assess implementation in diverse oncology settings, evaluate patient-centered outcomes and cost-effectiveness, and explore integration with cancer-specific pretest probability tools.