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This study investigated the histopathologic predictors of bilateral disease in low-risk PTC patients and the utility of preoperative ultrasonography in guiding completion thyroidectomy decisions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Patients treated with total thyroidectomy (TT) for low-risk PTCs (&lt; 4 cm) at the Endocrine Surgical Unit of the Royal North Shore Hospital, University of Sydney from 2013 to 2020 were identified from a prospectively maintained database. The primary objective was to evaluate whether specific histopathologic factors can reliably predict the likelihood of bilateral disease in low-risk PTC patients after hemithyroidectomy. The secondary objective was to assess the accuracy of preoperative ultrasonography for patients with bilateral disease.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Of the 737 patients in this study, 194 (26.3%) had bilateral disease. The multivariate analysis showed that larger median tumor size (odds ratio [OR] 1.043\u00a0per\u00a0mm; 95 % confidence interval [CI] 1.025\u20131.062; <jats:italic>P<\/jats:italic> &lt; 0.001), ipsilateral multifocal disease (MFD) (OR 2.010; 95% CI 1.338\u20133.020; <jats:italic>P<\/jats:italic> &lt; 0.001), and venous invasion (OR 1.693; 95% CI 1.058\u20132.707) had a significant association with bilateral disease. However, in the prediction of clinically significant contralateral disease (\u2265 10\u00a0mm), median tumor size (OR 1.104\u00a0per\u00a0mm; 95% CI 1.059\u20131.152; <jats:italic>P<\/jats:italic> &lt; 0.001) and venous invasion (OR 2.815; 95% CI 1.044\u20137.589; <jats:italic>P<\/jats:italic> = 0.041) were significantly correlated, whereas ipsilateral MFD lost its significance. These significant contralateral tumors were identified preoperatively and associated with higher Thyroid Imaging, Reporting and Data System (TIRADS) and\/or Bethesda cytology classifications in 94% of cases.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>In low-risk PTC patients, larger tumor size, venous invasion, and ipsilateral MFD are significantly associated with disease in the contralateral thyroid lobe.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1245\/s10434-024-16352-z","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T14:36:15Z","timestamp":1736865375000},"page":"2335-2343","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Predictors of Bilateral Disease in Low-Risk Papillary Thyroid Cancer: Histopathologic Insights and Preoperative Ultrasonography"],"prefix":"10.1245","volume":"32","author":[{"given":"P. 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