Abstract： Objective To investigate the value of contrast-enhanced spectral mammography(CESM)in the differential diagnosis of benign and malignant breast lesions.Methods A total of 67 patients(72 lesions)with ultrasonic or clinical suspec-ted breast diseases were selected.All patients were examined by conventional mammography(MG)and CESM.The results of MG and CESM in the diagnosis of benign and malignant breast lesions were observed.The pathological results obtained by surgical re-section or biopsy were used as the gold standard.The receiver operating characteristic(ROC)curve was drawn to analyze the di-agnostic efficiency of MG and CESM,and the area under the curve(AUC),sensitivity and specificity were calculated.Results 67 patients(a total of 72 lesions)were pathologically confirmed as malignant lesions(42 lesions)and benign lesions(30 lesions)by surgical resection or biopsy.Among the malignant breast lesions,the proportion of invasive ductal carcinoma was the highest(50.00％).Among the benign breast lesions,the proportion of fibroadenoma was the highest(25.00％).Taking the pathological results as the gold standard,the AUC value(0.960),sensitivity(0.966)and specificity(0.747)of CESM in the diagnosis of be-nign and malignant breast lesions were higher than those of MG(0.844,0.897,0.609).Conclusion CESM can be used as an optimal method for the differential diagnosis of benign and malignant breast lesions.The sensitivity and specificity of CESM in the diagnosis of breast cancer are higher than those of MG,which has high differential diagnosis value of benign and malignant breast lesions.