OBJECTIVE To evaluate the accuracy of endometrial cytology test (ECT) for the diagnosis of endometrial cancer or precancerous lesions and then discuss the value of ECT as a screening tool for endometrial cancer.Secondly, to investigate related characteristics and independent risk factors of epidemiology of endometrial carcinomas and atypical endometrial hyperplasia to advise proper crowd for endometrial carcinomas screening and monitoring. METHODS Totally 1717 preoperative questionnaires on hysteroscopy + dilation & curettage, histopathology and endometrial cytological tests in Peking University First Hospital, People's Hospital of Beijing Daxing District and Beijing Cancer Hospital, from March 2009 to May 2013 were completed. Histopathologic diagnoses were used as the gold standard for determining the accuracy of ECT.Extrapolation: applied binary logistic regression method to narrow down the risk factors of histopathology and endometrial cytological examination. RESULTS Satisfaction rate of cytological specimens and pathological specimens were 96.45% (1656/1717) and 91.44% (1570/1717), respectively. ECT provided sufficient material for the diagnosis significantly more often than histopathology (P < 0.05). For the ECT diagnosis of endometrial cancer: accuracy was estimated at 88.2%, sensitivity at 87.3%, specificity at 88.3%, positive predictive value (PPV) at 41.9%, negative predictive value (NPV)at 98.6%.Univariate analysis revealed that risk factors of diagnosis of endometrial carcinomas and atypical hyperplasia of histopathology were included:body mass index (BMI) ≥ 25 kg/m(2), age ≥ 40 years old, diabetes mellitus, hypertension, menopause, family history of malignant tumor (all P < 0.10). Multifactor analysis revealed that the independent risk factors were included:BMI ≥ 25 kg/m(2), age ≥ 40 years, menopause and family history of malignant tumor (all P < 0.05). CONCLUSIONS The results of the current study indicated that the accuracy of ECT for the diagnosis of endometrial cancer was high.Furthermore, ECT could be a useful tool for the screening of endometrial cancer.Independent risk factors of endometrial carcinomas and atypical endometrial hyperplasia including:age over 40 years, BMI ≥ 25 kg/m(2), menopause and family history of malignant tumor.