This present study was conducted over a 10-year period to investigate the hysteroscopic-view features of Endometrial Atypical Hyperplasia (EAH) and evaluate the accuracy of hysteroscopy imaging in detecting concurrent Endometrial Carcinoma (EC). A total of 69 patients diagnosed with EAH via hysteroscopy-guided biopsy and subsequently undergoing hysterectomy were eligible for analysis, and the uterine specimen histology was used as a reference for comparison. Of the included patients, EAH was confirmed in 40 women based on the hysterectomy specimens, while EC was identified in 29 cases (42.0% underestimation). Among the 40 patients with EAH, hysteroscopic-view reports of 37 cases (92.5%) indicated benign conditions, mostly diagnosed as polyps or hyperplasia. In the group of 29 women with underestimated EC, hysteroscopic-view agreed with the definitive diagnosis in 20 cases (68.9%), while in 9 patients, non-neoplastic patterns were observed. Overall, hysteroscopic imaging reported a benign endometrial overgrowth in 46 patients, and among them, EAH was identified in 37 cases based on the hysterectomy specimen (80.4%). Hysteroscopic-view demonstrated a sensitivity, specificity, negative predictive value, and positive predictive value of 76.3%, 93.0%, 81.6% and 90.6%, respectively, in predicting EC among patients who underwent hysteroscopic biopsy and received a diagnosis of EAH. However, no specific hysteroscopic features were associated with EAH diagnosis. Overall, despite hysteroscopic-view showing suboptimal sensitivity in detecting a concurrent EC, it can still exclude the presence of underlying EC in approximately 80% of patients when hysteroscopic imaging indicates a non-neoplastic growth.