OBJECTIVES: To investigate the capability of morphological and enhancement pattern analysis in contrast-enhanced mammography (CEM) to differentiate between benign and malignant papillary breast lesions. METHODS: This study involved 63 patients diagnosed with papillary breast lesions between January 2018 and December 2022. CEM was performed at two time intervals: between 2-3 min (T1, early phase) and 4-5 min (T2, later phase) after the injection of the contrast agent. For each patient, Breast Imaging Reporting and Data System (BI-RADS) lesion features were recorded. Kinetic enhancement patterns were evaluated for both phases based on these changes, followed by the measurement of diagnostic performance. RESULTS: Among the 63 female patients, a total of 86 lesions were identified, including 18 malignant ones, three intraductal papillomas without atypical proliferation, and 42 benign papillary lesions. The areas under receiver operating characteristic curves for CEM with kinetic enhancement and for CEM alone were 0.856 and 0.800, respectively. Assessing the diagnostic value, specificity, and accuracy of morphological categorization combined with kinetic enhancement showed higher values compared to those of the CEM morphological categorization alone (71.1% vs 60.0% and 79.4% vs 71.4%, respectively). However, the sensitivity and negative predictive value of the CEM with kinetic enhancement were similar to those of CEM alone (100% for all). CONCLUSION: For BI-RADS 3-5 papillary breast lesions, incorporating CEM kinetic enhancement to morphological patterns improved the confidence level in diagnosis. ADVANCES IN KNOWLEDGE: This article provides valuable references for distinguishing benign and malignant breast papillary lesions.