Objective To explore the accuracy of hysteroscopy as a diagnosis for endometrial carcinoma and to determine if the procedure increase the rate of positive peritoneal cytology in the patients. Methods The peritoneal cytology of 36 patients with endometrial carcinoma diagnosed by D&C or hysteroscopy was retrospectively analyzed. Results The peritoneal cytology was positive in 1 (5.9%) of the 17 cases diagnosed by D&C and 2 (10.5%) of the 19 cases diagnosed by hysteroscopy (P=1.000). Based on the pathological examination,the accuracy of D&C was 52.9% (9/17),which was significantly lower than that of hysteroscopy [89.5% (17/19),P=0.025]. In the cases with stage Ⅰ endometrial carcinoma,the diagnostic accordance rate of hysteroscopy was 85.7% (12/14),while that of the D&C was 42.9% (6/14,P=0.040). The 36 patients were followed up for 2 months to 4 and a half year (over 1 year in 28 cases). One patient with Ⅲc stage carcinoma died of recurrent tumor in 2 years after the treatment. Conclusion Hysteroscopy shows higher diagnosis accuracy with no evidence indicating an increased rate of positive peritoneal cytology compared to D&C.