Objective: To compare the sensitivity and specificity of diffusion weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) in the differentiation of benign and malignant breast lesions. Methods: Scopus, PubMed, and other registries were searched up to April 2023. We included diagnostic studies with DWI and MRS as index tests and histopathologic examination as the reference standard for differentiating benign and malignant breast lesions in adult females. We excluded studies involving healthy women, only breast cancer patients, and non-comparative diagnostic accuracy studies on either index test. The sensitivity and specificity of DWI and MRS were investigated and pooled using random-effect bivariate meta-analysis. Risk of bias was assessed using QUADAS-2. Evidence quality was summarized using GRADE. Results: Eight eligible studies involving 632 females and 687 breast lesions were identified. The pooled sensitivity and specificity of DWI were 92% (CI 85–96%) and 88% (CI 75–94%), respectively. The pooled sensitivity and specificity of MRS were 85% (CI 66–94%) and 85% (CI 77–91%), respectively. No significant difference was noted in the sensitivity (7%, CI –8–22%) and specificity (3%, CI –9–14%) between DWI and MRS. Conclusions: In low to moderate quality evidence, DWI and MRS show comparable sensitivity and specificity in differentiating benign and malignant breast lesions. © 2023 Elsevier B.V.