The aim of this retrospective study was to compare stage, disease-free survival and overall survival in patients suffering from endometrial cancer who underwent hysteroscopy and those who did not. Between January I, 1990 and June 30, 2001, 181 patients were referred to our Gynaecologic Department for primary endometrial carcinoma; from clinical charts we reviewed the personal and pathological data of all patients. Patients were divided into two groups: those with hysteroscopy (69 patients) and those without (112 patients). Endometrial biopsy was performed at the end of hysteroscopy. We compared symptoms at diagnosis, stage and survival. Hysteroscopy demonstrates a high diagnostic accuracy for endometrial cancer. In our case series we obtained a sensitivity of 93.10%, specificity of 99.96%, positive predictive value of 98.18% and negative predictive value of 99.85%; when hysteroscopy was associated with endometrial biopsy the sensitivity was 96.55% and specificity 100%. In this study we had a significant difference in stage Ia; in the group with hysteroscopy, stage Ia cases were 23.2% while in the group without, stage Ia cases were 15.2%. Survival in stage Ia only was 100% and 91.7%, respectively, at three and five years. In conclusion hysteroscopy was found to have a very important role in the early diagnosis of endometrial cancer, especially when it is limited to the mucosa! surface.