Objective To evaluate the diagnostic performance of SMI in the diagnosis of benign and malignant breast lesions. Methods A systematic search of PubMed, EMBASE, Cochrane, OVID, SCI, and SCOPUS was performed to find relevant studies which applied SMI to differentiate benign and malignant breast lesions. All the studies were published before October 10, 2022. Only studies published in English were collected. Quality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2) tool was applied to assess the quality of the included studies. Summary receiver operating characteristic (SROC) modeling was also performed to the diagnostic performance of SMI in the diagnosis of benign and malignant breast lesions. Subgroup analyses and meta‐regression were performed to find out the heterogeneity. Results Twenty studies which include a total of 2873 lesions (1748 benign and 1125 malignant) in 2740 patients were evaluated in this meta‐analysis. The summary sensitivity and specificity were 0.82 (95% confidence interval [CI]: 0.76–0.86), 0.70 (95% CI: 0.64–0.76) for SMI vascular degree, 0.77 (95% CI: 0.67–0.84), 0.79 (95% CI: 0.75–0.83) for SMI vascular distribution, 0.78 (95% CI: 0.70–0.84), 0.75 (95% CI: 0.69–0.80) for SMI vascular morphology, 0.81 (95% CI: 0.72–0.87), 0.80 (95% CI: 0.75–0.85) SMI penetration vessel. For SMI overall vascular features, the summary sensitivity and summary specificity were 0.74 (95% CI: 0.61–0.84) and 0.80 (95% CI: 0.76–0.84). The result of subgroup analysis and meta‐analysis showed malignant rate and country might be the cause of heterogeneity of diagnostic accuracy of vascular grade and morphology. Conclusion SMI vascular features have high sensitivity and specificity in the differentiation of benign and malignant lesions. Future international multicenter studies in various regions with large sample size are required to confirm these findings.