Your pathology report for negative for intraepithelial lesion or malignancy (NILM)

by Omar Al-Nourhji MD FRCPC
August 29, 2025

Negative for intraepithelial lesion or malignancy (NILM) is the most common and reassuring result from a Pap smear. It means that no precancerous or cancerous cells were found in the sample from your cervix. In other words, it is considered a normal result.

How do pathologists make this diagnosis?

The Pap smear is a screening test for cervical cancer. A small brush or spatula is used to gently collect cells from the surface of the cervix. These cells are placed on a glass slide or into a liquid solution and sent to the laboratory.

A laboratory technologist, called a cytotechnologist, or a pathologist, then examines the sample under the microscope. In a Pap smear reported as NILM, only normal cells are observed. These can include:

To ensure the test is accurate, the sample must contain enough squamous cells. The presence of endocervical or metaplastic cells is considered a quality indicator because it shows that the transformation zone was sampled, but these cells are not required for the test to be considered valid.

Sometimes, other findings may be reported along with NILM. These can include:

  • Infections such as yeast, bacteria, or viruses.

  • Normal endometrial cells that have shed from the lining of the uterus.

These findings do not change the NILM result but may be noted in your report.

What happens after this diagnosis?

Because NILM is a normal result, most people can continue with routine cervical cancer screening. How often you need a Pap smear depends on:

  • Your age.

  • Whether you have also been tested for human papillomavirus (HPV), the virus that can increase the risk of cervical cancer.

For many patients, screening is recommended every three to five years if both the Pap smear and HPV test are normal. However, your doctor may adjust the schedule based on your personal medical history.

Can NILM be used for anal Pap smears?

Yes. The same reporting system that is used for cervical Pap smears is also applied to anal Pap smears. In this setting, NILM means that no precancerous or cancerous cells were seen in the sample taken from the lining of the anus. Anal Pap smears are sometimes used in people who are at higher risk for anal cancer, such as those with a history of human papillomavirus (HPV) infection or a weakened immune system.

Just like with cervical screening, a result of NILM on an anal Pap smear is considered normal and reassuring. Your doctor will determine the appropriate follow-up interval based on your risk factors and medical history.

Can NILM be used for other parts of the body?

No. The term negative for intraepithelial lesion or malignancy (NILM) is used only to report results from Pap smears of the cervix or the anal canal. Pap smears are a special type of screening test designed to look for precancerous or cancerous changes in both of these areas of the body.

Although other parts of the body may also be examined with cytology (the study of cells under the microscope), different terminology is used for those tests. For example, urine cytology, fluid cytology, or fine-needle aspiration biopsies have their own reporting systems. NILM is specific to Pap smear screening of the cervix and anal canal.

Questions for your doctor

  • How often should I have a Pap smear based on my age and medical history?

  • Was an HPV test also performed, and what were the results?

  • Were there any other findings on my Pap smear, such as signs of infection?

  • Do I need any follow-up testing or treatment at this time?

  • What symptoms should I watch for between screenings?

Other helpful resources

Choosing Wisely Canada

Cancer Care Ontario

Canadian Cancer Society

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