Purpose: In PIK3CA mutant breast cancer, downstream hyperactivation of the PI3K/AKT/mTOR pathway may be associated with increased glycolysis of cancer cells. The purpose of this study was to investigate the functional association of PIK3CA mutational status and tumor glycolysis in invasive ER+/HER2− early breast cancer. Procedures: This institutional review board-approved retrospective study included a dataset of 67 ER+/HER2− early breast cancer patients. All patients underwent 2-deoxy-2-[ 18 F]fluoro-Dglucose positron emission tomography/X-ray computed tomography ([ 18 F]FDG PET/CT) and clinico-pathologic assessments as part of a prospective study. For this retrospective analysis, pyrosequencing was used to detect PIK3CA mutations of exons 4, 7, 9, and 20. Tumor glucose metabolism was assessed semi-quantitatively with [ 18 F]FDG PET/CT using maximum standardized uptake values (SUV max). SUV max values were corrected for the partial volume effect, and metabolic tumor volume was calculated using the volume of interest automated lesion growing function 2D tumor size, i.e., maximum tumor diameter was assessed on concurrent pretreatment contrast-enhanced magnetic resonance imaging. Results: PIK3CA mutations were present in 45 % of all tumors. Mutations were associated with a small tumor diameter (p G 0.01) and with low nuclear grade (p = 0.04). Glycolytic activity was positively associated with nuclear grade (p = 0.01), proliferation (p = 0.002), regional lymph node metastasis (p = 0.015), and metabolic tumor volume (p = 0.001) but not with tumor size/T-stage. Heinrich Magometschnigg and Katja Pinker as well as Peter Dubsky and Martin Filipits contributed equally to this work.