YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism in Patients With Cancer: A Randomized Clinical Trial. (Therapy)
Akerboom B, et al. JAMA. 2026 Aug 25;336(8):655-663. doi: 10.1001/jama.2026.10676.
Editorial: Ruling Out PE in Cancer-Can YEARS Reduce CT Imaging?
Han HB, et al. JAMA. 2026 Aug 25;336(8):642-643. doi: 10.1001/jama.2026.12480.
Methodology 3/5
Usefulness 3.5/5
Question and Methods: Open-label, multicenter, noninferiority RCT with blinded outcome adjudication to determine if the YEARS algorithm can safely and efficiently rule out PE in cancer patients vs CTPA-only?
Findings: Among 698 patients, primary outcome was 1.8% in YEARS group vs 5.5% in CTPA-only (absolute risk difference -3.7%; 99.9% CI, -8.8% to 1.4%; meeting noninferiority criteria. YEARS avoided CTPA in 22% of patients.
Limitations: Open-label study stopped early at interim analysis, adjusted noninferiority margin, intention to diagnose results narrowly met threshold, 5/15 primary outcomes were unconfirmed possible PE deaths.
Interpretation: Despite meeting noninferiority, open-label design, adjusted margins, unconfirmed deaths, and no high-risk cancer subgroup analysis, I wouldn’t adopt this yet.
