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Background: The prognostic value of preoperative fluorine-18-fluorodeoxyglucose positron-emission tomography ( 18 F-FDG PET) scan for determining overall survival (OS) in breast cancer (BC) patients is controversial., Aim: To evaluate the OS predictive value of preoperative PET positivity after 15 years., Methods: We performed a retrospective search of the Universitair Ziekenhuis Brussel patient database for nonmetastatic patients who underwent preoperative PET between 2002-2008. PET positivity was determined by anatomical region of interest (AROI) findings for breast and axillary, sternal, and distant sites. The prognostic role of PET was examined as a qualitative binary factor (positive vs negative status) and as a continuous variable [maximum standard uptake value (SUVmax)] in multivariate survival analyses using Cox proportional hazards models. Among the 104 identified patients who received PET, 36 were further analyzed for the SUVmax in the AROI., Results: Poor OS within the 15-year study period was predicted by PET-positive status for axillary ( P = 0.033), sternal ( P = 0.033), and combined PET-axillary/sternal ( P = 0.008) nodes. Poor disease-free survival was associated with PET-positive axillary status ( P = 0.040) and combined axillary/sternal status ( P = 0.023). Cox models confirmed the long-term prognostic value of combined PET-axillary/sternal status [hazard ratio (HR): 3.08, 95% confidence interval: 1.42-6.69]. SUVmax of ipsilateral breast and axilla as continuous covariates were significant predictors of long-term OS with HRs of 1.25 ( P = 0.048) and 1.54 ( P = 0.029), corresponding to relative increase in the risk of death of 25% and 54% per SUVmax unit, respectively. In addition, the ratio of the ipsilateral axillary SUVmax over the contralateral axillary SUVmax was the most significant OS predictor ( P = 0.027), with 1.94 HR, indicating a two-fold relative increase of mortality risk., Conclusion: Preoperative PET is valuable for prediction of long-term survival. Ipsilateral axillary SUVmax ratio over the uninvolved side represents a new prognostic finding that warrants further investigation., Competing Interests: Conflict-of-interest statement: The authors declare that they have no financial relationships to disclose., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)