OBJECTIVE: This study aims to assess the value of radiomics features integrated with clinical characteristics for estimating Ki67 expression in patients with breast cancer (BC). METHODS: In total, 114 patients with BC performed RESULTS: The N stage, tumor morphology, SUVmax, and the longest diameter significantly differed between Ki67 + and Ki67- groups (all CONCLUSIONS: PET/CT image-based radiomics features combined with clinical features have the potential to predict Ki67 expression in BC. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13139-024-00896-9.