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18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) can reveal the metabolic activity of malignant tumors. Recent advances gained from molecular studies suggest that tumor biology can be a good predictor of prognosis in breast cancer. We compared the ability of maximum standardized uptake values (SUV max ) derived by FDG-PET with tumor burden in predicting tumor recurrence for patients with breast cancer.    Methods  496 patients with breast cancer who underwent preoperative FDG-PET between April 2004 and May 2009 were retrospectively identified. SUV max  was obtained by FDG-PET, and the cutoff point was defined using a time-dependent receiver operating characteristic curve for recurrence-free survival (RFS). The primary endpoint was RFS.    Results  In multivariate analysis for RFS, SUV max  carried independent prognostic significance (hazard ratio, 2.39; 95% confidence interval, 1.20 to 4.76;  P  = 0.012). When the patients were classified into four groups according to the combined factors of tumor size (≤2 cm versus >2 cm) and SUV max  (<4 versus ≥4), RFS differed significantly ( P  < 0.001). Similarly, SUV max  had prognostic value in combination with nodal status (negative versus positive) or stage (I versus II and III) ( P  < 0.001 and  P  = 0.001, respectively). In hormone receptor–positive disease, SUV max  remained a significant prognostic factor for RFS based on multivariate analysis.    Conclusions  Our results highlight the prognostic value of FDG-PET in prediction of tumor relapse for patients with breast cancer. Particularly in patients with hormone receptor–positive disease, the tumor metabolic information provided by FDG-PET is more significantly correlated with prognosis than tumor burden.    Electronic supplementary material  The online version of this article (doi:10.1186/s13058-014-0502-y) contains supplementary material, which is available to authorized users.

breast cancer research

Standardized uptake value of 18F-fluorodeoxyglucose positron emission tomography for prediction of tumor recurrence in breast cancer beyond tumor burden