Preoperative diagnosis of endometrial pathology is essential for the outcome of treatment. It is important to preoperatively detect the malignant potential of changes and choose an adequate therapeutic approach. This is especially important for women who have not completed their reproduction in terms of choosing minimally invasive operative methods and preserving their fertile potential. It is very important to optimize the preoperative ultrasound examination of endometrial tumors concerning the differential diagnosis of an endometrial benign and malignant lesion, as well as the type of tumor, and to assess the degree of myometrial invasion of malignant lesions. The performance of the use of three-dimensional/four-dimensional (3D/4D) ultrasound in diagnostics, especially in the analysis of certain endometrial pathologies, has already been established and provides very useful information. However, the morphological and vascular characteristics might correlate with tumor stage, grade, and size, and that information could be of benefit in the assessment of the preoperative tumor and perhaps be used in risk evaluation in the future. Exploratory curettage and pathohistological findings of endometrial pathology are the gold standard, but in some cases, even these methods, which depend on several variables, do not provide a definitive, accurate diagnosis. This is why, in combination with new ultrasound techniques, the effectiveness of preoperative diagnosis of pathological changes in the endometrium increases.