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The technique is valuable for predicting the prognosis of patients with recurrent breast cancer and for determining and predicting the outcomes of neoadjuvant chemotherapy

FDG-PET/CT is useful not only for evaluating metastasis but also for predicting the prognosis of recurrent breast cancer and measuring treatment effects

reports remain limited to small-scale clinical trials of about 100 patients.

MaxSUV, which is the most popular FDG-PET/CT value, can vary up to 30 % because of differences among PET/CT devices and among the operators who create the images

the degree of malignancy would increase with an increase in maxSUV when ER or HER-2 signaling is involved.

Factors that determine the rate of cancer progression include T-factor (tumor diameter) and N-factor (presence or absence/number of lymph node metastasis)

The prognostic factors applied in breast cancer can be broadly divided into those that determine staging and those that determine biological tumor characteristics

Prognosis was previously predicted based on T, N, and M staging, which indicates the degree of progression. However, prognosis is now predicted and treatment regimes are presently selected by also considering ER and HER-2 levels, which determine the nature of the tumor

maxSUV presently serves as an indicator of metabolic activity during cancer therapy. For instance, the maxSUV of primary lung and hematological cancer lesions correlates with metastasis and prognosis, whereas maxSUV also seems useful for predicting the prognosis of recurrent breast cancer and in determining and predicting the outcome of neoadjuvant chemotherapy

The maxSUV cut-off calculated from ROC curves for recurrence was 3.0

Factors that determine the nature of tumors also include ER, HER-2, Ki-67 labeling index, and nuclear grade

both ER status and maxSUV as independent prognostic factors

maxSUV has a closer correlation with prognosis

maxSUV, clinical T-factor and ER were significant prognostic factors

Our results showed that maxSUV has the potential to be a novel prognostic factor and that it can be used to determine future therapies

primary tumor SUVmax >10 predicted survival, independent of the tumor stage and diameter

advanced tumors tend to have higher FDG uptake (and thus higher SUV values)

the impact of the SUV on treatment outcome has been observed even within a given tumor stage

The association between FDG uptake and tumor burden or stage has been well documented

FDG uptake not only reflects tumor burden/stage but also expresses, at least in part, some intrinsic biologic characteristic(s) of the tumor

SUVmax reflects the highest voxel value within the ROI or VOI. It is the most widely used parameter to measure metabolic tumor activity in oncologic FDG-PET/CT imaging

Several studies suggest that primary tumor baseline SUVmax also has predictive value in assessing the tumor burden, lymph node involvement and local extension

According to EORTC, a drop (delta between baseline and post-therapy) of 15–25% in SUVmax may represent a good treatment response

PERCIST criteria was proposed by the investigators at the Johns Hopkins Medical Institutions and suggested that a decrease in SUV normalized to lean body mass of at least 30% should be achieved before considering partial tumor response