The goal of the study described here was to compare the automatic breast volume scanner (ABVS) and handheld ultrasound (HHUS) with respect to diagnostic performance in the differential diagnosis of benign and malignant breast lesions. A literature search of the PubMed, EMBASE and Cochrane Library databases through 30 June 2018 was conducted. Pooled sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratios of the ABVS and HHUS were calculated, and summary receiver operating characteristic (SROC) curves were drawn. A total of nine studies, including 1985 lesions (628 malignant and 1357 benign) from 1774 patients, were analyzed. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio for ABVS were 90.8% (95% confidence interval: 88.3%-93.0%), 82.2% (80.0%-84.2%), 5.39 (4.26-6.80), 0.10 (0.06-0.15) and 61.68 (32.31-117.76); those for HHUS were 90.6% (88.1%-92.8%), 81.0% (78.8%-83.0%), 5.22 (3.14-8.67), 0.11 (0.08-0.17) and 52.60 (32.06-86.35), respectively. The areas under the SROC curves in the differentiation of benign and malignant breast lesions were 0.93 and 0.94 for ABVS and HHUS, respectively, which were not significantly different (p = 0.853). In conclusion, based on available evidence in the literature, ABVS the diagnostic performance of the ABVS is similar to that of HHUS in the differentiation of benign and malignant breast lesions.