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This prospective single-center study compared [\n                      <jats:sup>68<\/jats:sup>\n                      Ga]Ga-FAPI-04 PET\/MRI, [\n                      <jats:sup>18<\/jats:sup>\n                      F]FDG PET\/CT, and contrast-enhanced MRI for predicting pathologic response after NAC.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Women with biopsy-confirmed stage II\u2013III breast cancer underwent baseline and post-therapy [\n                      <jats:sup>68<\/jats:sup>\n                      Ga]Ga-FAPI-04 PET\/MRI, [\n                      <jats:sup>18<\/jats:sup>\n                      F]FDG PET\/CT, and contrast-enhanced MRI before surgery. PET parameters were analyzed for primary tumors and axillary nodes. Selected variables were evaluated using LASSO and receiver-operating-characteristic analyses. Stromal FAP expression was assessed immunohistochemically in paired specimens.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-four patients completed the protocol, yielding 25 primary lesions and 44 metastatic lymph nodes across 27 axillary compartments. The pCR rate was 60.00% for primary lesions and 72.73% for axillary nodes. For primary-lesion response, post-therapy [\n                      <jats:sup>68<\/jats:sup>\n                      Ga]Ga-FAPI-04 SUVmax showed the highest performance (AUC, 0.84; sensitivity, specificity, and accuracy, 80.00% each); the best [\n                      <jats:sup>18<\/jats:sup>\n                      F]FDG parameter was \u0394TBR% (AUC, 0.747). For nodal response, post-therapy [\n                      <jats:sup>68<\/jats:sup>\n                      Ga]Ga-FAPI-04 SULmean showed the highest performance (AUC, 0.89; sensitivity, 91.67%; specificity, 81.25%; accuracy, 84.09%) and exceeded the best [\n                      <jats:sup>18<\/jats:sup>\n                      F]FDG parameter on DeLong testing. MRI AUCs were 0.733 and 0.770 for primary and nodal disease, respectively. Stromal FAP expression correlated positively with [\n                      <jats:sup>68<\/jats:sup>\n                      Ga]Ga-FAPI-04 SUVmax.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Post-therapy [\n                      <jats:sup>68<\/jats:sup>\n                      Ga]Ga-FAPI-04 PET may provide useful adjunctive information for response assessment after NAC in breast cancer, particularly for axillary nodal evaluation, potentially supporting more individualized preoperative planning.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov, NCT07553741, retrospectively registered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00259-026-08091-y","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T08:02:20Z","timestamp":1784793740000},"page":"7221-7232","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prospective comparison of [68Ga]Ga-FAPI-04 PET\/MRI, [18F]FDG PET\/CT, and contrast-enhanced MRI for predicting pathologic complete response after neoadjuvant chemotherapy in breast cancer"],"prefix":"10.1007","volume":"53","author":[{"given":"Yuming","family":"Luo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runze","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yalan","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bei","family":"Qian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunxiao","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengting","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqi","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silin","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huanwei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hengyu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Lan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1587-1215","authenticated-orcid":false,"given":"Chunping","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"8091_CR1","doi-asserted-by":"publisher","first-page":"1485","DOI":"10.1200\/JCO.20.03399","volume":"39","author":"LA Korde","year":"2021","unstructured":"Korde LA, Somerfield MR, Carey LA, et al. 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Approval was granted by the Ethics Committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (No. UHCT250235).","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from all individual participants included in the study.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors affirm that human research participants provided informed consent for publication of the images included in this article.","order":3,"name":"Ethics","label":"Consent to publish","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"ClinicalTrials.gov, NCT07553741, retrospectively registered.","order":4,"name":"Ethics","label":"Clinical trial registration","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"A preprint version of this manuscript has been posted on medRxiv (\n                      \n                      IF: NA NA NA).","order":5,"name":"Ethics","label":"Preprint disclosure","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Xiaoli Lan serves as an editor for the European Journal of Nuclear Medicine and Molecular Imaging. She was not involved in the editorial handling, peer-review process, or decision-making for this manuscript. The remaining authors declare that they have no relevant financial or non-financial interests to disclose.","order":6,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}