Can YEARS safely reduce CT scans in cancer patients with suspected PE?

Clinical takeaway: Consider using the YEARS diagnostic algorithm to evaluate suspected pulmonary embolism in patients with active cancer. In this trial, the approach safely avoided CTPA in 22% of patients while maintaining a very low 90-day rate of missed venous thromboembolism.

Patients with cancer are at high risk for pulmonary embolism (PE), but current practice often sends nearly all patients with suspected PE directly for CT pulmonary angiography (CTPA), exposing many to unnecessary radiation, contrast, cost, and delays.

The randomized HYDRA trial enrolled 698 adults with active cancer and suspected PE, comparing a diagnostic strategy based on the YEARS algorithm with a CTPA-only approach. PE was diagnosed at presentation in 15% of participants. Among patients in whom PE was ruled out, the 90-day rate of symptomatic venous thromboembolism or PE-related death was 1.8% with the YEARS strategy versus 5.5% with routine CTPA, meeting the study's criteria for noninferiority. Overall, the YEARS algorithm eliminated the need for CTPA in 22% of patients, while the proportion of negative CT scans among those who underwent imaging remained similar between groups.

"The YEARS diagnostic algorithm is as safe as CTPA only in excluding PE in patients with cancer," the investigators concluded, noting that its use "obviated the need to perform a CTPA in 22% of patients."

The findings challenge the longstanding practice of routinely proceeding directly to CTPA in patients with cancer and suspected PE. If adopted more broadly, the YEARS algorithm could reduce unnecessary imaging, lower radiation and contrast exposure, decrease costs, and improve emergency department efficiency while maintaining diagnostic safety.

Source: Akerboom B, et al. (2026 July 12) JAMA. YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism in Patients With Cancer: A Randomized Clinical Trial