YEARS safely avoids scans in cancer

In stable patients with active cancer and suspected pulmonary embolism, the YEARS algorithm was as safe as immediate computed tomography and avoided scans in 22%.
*Randomized noninferiority diagnostic trial; Level 2 (OCEBM).

Citation

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

Background

Patients with cancer have a high risk of lung blood clots, but computed tomography scans add radiation, contrast exposure, cost, and time. Guidelines often recommend scanning these patients directly because evidence for clinical rule-out tools has been limited.

Patients

698 adults with active cancer and suspected acute pulmonary embolism at 21 European hospitals. Key exclusions included unstable circulation, need for full-dose blood thinners for another reason, scan contraindication, or life expectancy under 3 months.

Intervention

YEARS algorithm: 3 bedside findings plus a D-dimer blood test, with computed tomography only when indicated.

Control

Immediate computed tomography pulmonary angiography for all patients, the current standard approach.

Outcome

Primary: symptomatic venous clot or possible pulmonary embolism-related death within 90 days after pulmonary embolism was ruled out at baseline.

Follow-up Period

90 days.

Results

Outcome YEARS Scan-only Effect
Venous clot or possible pulmonary embolism-related death (primary) 5/282 (1.8%) 15/273 (5.5%) Noninferiority met; absolute difference −3.7% (99.9% CI, −8.8% to 1.4%)
Computed tomography avoided 77/352 (22%) 0% by design About 1 scan avoided per 5 patients tested

CI = confidence interval; D-dimer = blood test that rises when clots may be present.

The primary analysis was per protocol; an intention-to-diagnosis analysis also met noninferiority. This was a noninferiority trial with a 2.6% prespecified margin.

Limitations

Patients and clinicians were not blinded. The trial stopped after an interim analysis. Results may not apply to unstable patients or those with expected survival under 3 months. Subgroup results by cancer type or stage were not available.

Funding

Nonprofit network and hospitals; no commercial funding.

Clinical Application

For stable cancer patients with suspected pulmonary embolism, consider YEARS before scanning to safely reduce unnecessary computed tomography.