The aim of this prospective study was to assess the predictive value of 18 F-FDG PET/CT imaging for pathologic response to neoadjuvant chemotherapy (NACT) and outcome in inflammatory breast cancer (IBC) patients. Methods: Twenty-three consecutive patients (51 y ± 12.7) with newly diagnosed IBC, assessed by PET/CT at baseline (PET1), after the third course of NACT (PET2), and before surgery (PET3), were included. The patients were divided into 2 groups according to pathologic response as assessed by the Sataloff classification: pathologic complete response for complete responders (stage TA and NA or NB) and non-pathologic complete response for noncomplete responders (not stage A for tumor or not stage NA or NB for lymph nodes). In addition to maximum standardized uptake value (SUV max ) measurements, a global breast metabolic tumor volume (MTV) was delineated using a semiautomatic segmentation method. Changes in SUV max and MTV between PET1 and PET2 (DSUV1-2; DMTV1-2) and PET1 and PET3 (DSUV1-3; DMTV1-3) were measured. Results: Mean SUV max on PET1, PET2, and PET3 did not statistically differ between the 2 pathologic response groups. On receiver-operating-characteristic analysis, a 72% cutoff for DSUV1-3 provided the best performance to predict residual disease, with sensitivity, specificity, and accuracy of 61%, 80%, and 65%, respectively. On univariate analysis, the 72% cutoff for DSUV1-3 was the best predictor of distant metastasis-free survival (P 5 0.05). On multivariate analysis, the 72% cutoff for DSUV1-3 was an independent predictor of distant metastasis-free survival (P 5 0.01). Conclusion: Our results emphasize the good predictive value of change in SUV max between baseline and before surgery to assess pathologic response and survival in IBC patients undergoing NACT.