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The purpose of this study was to systematically review and evaluate the diagnostic accuracy of contrast-enhanced sonography in the differential diagnosis of benign and malignant breast lesions.The scientific literature databases PubMed and Embase were comprehensively searched for relevant studies before January 2015. Data were pooled to yield the summary sensitivity, specificity, and diagnostic odds ratio using meta-analysis software.A total of 29 studies with 2296 lesions were included in the analysis. The pooled sensitivity and specificity were 0.88 (95% confidence interval [CI], 0.86–0.90; inconsistency index [I2] = 77.9%) and 0.80 (95% CI, 0.78–0.83; I2 = 84.0%), respectively. The pooled diagnostic odds ratio was 30.35 (95% CI, 15.75–58.48; I2= 82.1%), and the area under the summary receiver operating characteristic curve was 0.9115 (SE, 0.0243).The comprehensive results suggest that contrast-enhanced sonography could be a potentially effective method for differential diagnosis of benign and malignant breast lesions.