Abstract: Objective To investigate the value of hysteroscopy in the diagnosis of benign and malignant endometrial lesions in middle-aged and elderly patients. Methods A total of 119 middle-aged and elderly patients were selected in our hospital from January 2014 to December 2016. All cases were divided into observation group (hysteroscopic operation, n=62) and control group(fractional curettage, n=57) according to different preoperative diagnostic methods. Clinical data about patients in the two groups and the accuracy of two diagnostic methods for benign and malignant endometrial lesions were compared. Results There was no significant difference between the two groups in age, body mass index and pathological diagnosis (All P> 0.05). The sensitivity, positive predictive value and diagnosis accuracy of the observation group in the diagnosis of endometrial carcinoma and precancerous lesions were significantly higher than those of the control group (91.7% vs 73.2%, 100.0% vs 78.9%, 90.3% vs 75.4%, all P< 0.05), while the specificity and negative predictive value of the two groups showed no statistically significance (85.7% vs 81.3%, 75.0% vs 68.4%, P> 0.05, respectively). Conclusion For middle-aged and elderly patients with endometrial carcinoma and precancerous lesions, hysteroscopy improves diagnostic accuracy and helps clinicians make right decisions.