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18F-fluorodeoxyglucose (18F-FDG) uptake may identify poorly differentiated tumors with a high proliferation rate that are more responsive to neoadjuvant chemotherapy.We retrospectively evaluated 273 patients (mean age, 44.2 years; range 23–78 years) newly diagnosed with stage II or III invasive ductal breast cancer between 2006 and 2010. All patients were treated with neoadjuvant chemotherapy followed by surgery. The ability of parameters to predict pathological complete response (pCR), was assessed by multivariate analysis.Of the 273 breast cancer patients, 30 (11.0%) achieved pCR. Univariate analysis revealed that higher histologic grade (P < 0.001), lack of estrogen receptor (ER, P < 0.001); and a higher maximal standardized uptake value (SUVmax, P < 0.001) were associated with pCR, whereas HER2/neu amplification and Ki-67 expression were not (P > 0.05 for each comparison). Multivariate analysis showed that negative ER (odds ratio [OR] = 9.98; 95% confidence interval [CI], 2.88–34.52, P < 0.001) and the SUVmax of 18F-FDG uptake (OR per one unit increase in SUVmax = 1.09; 95% CI, 1.02–1.16, P = 0.008) were independent predictors of pCR.ER status and 18F-FDG uptake are independent predictors of pCR after neoadjuvant chemotherapy for breast cancer. J. Surg. Oncol. 2013;107:180–187. © 2012 Wiley Periodicals, Inc.