Prognostic Value of Blood-Based P-Tau217 Levels for Progression to Cognitive Impairment, YEARS Algorithm for Diagnosis of PE in Patients With Cancer, HPV Screening and Self-Collected Vaginal Samples, and more

Thanks, Kirsten.

Our first article is on a topic relevant to many clinicians, patients with cancer who present with suspected pulmonary embolism or PE.

This group of patients are at high risk for PE and are often sent straight to CT pulmonary angiography with the associated radiation, contrast exposure, and cost.

Dr. Akerboom and colleagues ran a multicenter randomized non-inferiority trial to see if the YEARS algorithm, a decision rule that uses three clinical items and a D-dimer threshold, can safely avoid CT scans in some patients.

They randomly assigned almost seven hundred patients with active cancer to evaluation either with the YEARS algorithm or default CT scan at twenty-one hospitals in six countries.

The investigators report that among those with PE excluded at baseline, one point eight percent of the YEARS group participants suffered venous thromboembolism or PE-related death within ninety days, compared with five point five percent in the CT-only group, which was the primary outcome.

So fewer events in the YEARS algorithm group, not more.

And twenty-two percent of patients in the YEARS group avoided a CT scan altogether.

The bottom line, in this high-risk cancer population, using the YEARS diagnostic algorithm was as safe as sending everyone to CT pulmonary angiography, and it obviated the need for a scan in roughly one in five patients.

In an accompanying editorial, Drs.

Han and Beckman point out that although the YEARS pathway won't be more accurate than CT pulmonary angiography itself, this trial is a real advance.

The editorialists caution about generalizing until we have more cancer type specific data and suggest that future studies explore tailored D-dimer thresholds in cancer subpopulations.

But for now it appears that clinicians have evidence that systematic decision tools can safely reduce imaging in select patients where PE is suspected.