Negative for Intraepithelial Lesion or Malignancy (NILM): Understanding Your Pathology Report

by Omar Al-Nourhji MD FRCPC
May 14, 2026

Negative for intraepithelial lesion or malignancy (NILM) is the most common and reassuring result on a Pap test (also called a Pap smear). It means that the cells collected from your cervix showed no signs of precancerous change or cancer. In most situations, NILM is considered a normal result. This article will help you understand what NILM means, what was examined to reach this conclusion, and what steps come next for your care.

How is the diagnosis made?

A Pap test is a screening test designed to detect early changes in the cells of the cervix before they can develop into cancer. During the test, a small brush or spatula is used to gently collect cells from the surface of the cervix. The cells are placed onto a glass slide or into a liquid solution and sent to a pathology laboratory for examination.

In the laboratory, a specially trained medical professional, such as a cytotechnologist or a pathologist, examines the cells under the microscope. A result of NILM means that only normal-appearing cells were seen in the sample. These can include:

Squamous cells — flat cells that form the outer surface of the cervix.
Glandular cells — cells that line the inside of the cervical canal and produce mucus.
Metaplastic cells — normal transitional cells that form in the transformation zone. The transformation zone is the area where the outer surface of the cervix meets the inner canal — the region where most precancerous changes and cervical cancers begin.

For a Pap test to be considered adequate, the sample must contain a sufficient number of squamous cells. The presence of endocervical or metaplastic cells is noted as a quality indicator because it confirms that the transformation zone was sampled. However, the absence of these cells does not automatically make the test invalid — your doctor will interpret the result in the context of your full medical history.

What other findings may be reported?

Sometimes, additional observations are noted alongside the NILM result. These findings do not change the overall normal interpretation but may influence your doctor’s recommendations for follow-up:

Organisms — The report may note the presence of Candida (a type of yeast), Trichomonas vaginalis (a sexually transmitted parasite), or a bacterial pattern called bacterial vaginosis. These are common, treatable infections and are not signs of cancer.
Normal endometrial cells — Cells shed from the lining of the uterus (called the endometrium) may appear in a Pap test, particularly around the time of menstruation. In most people, this is a normal finding. However, in people aged 45 and older, your doctor may recommend further evaluation to ensure the endometrial cells do not indicate an underlying problem.
Reactive cellular changes — The cells of the cervix may look slightly different in response to inflammation, infection, a prior procedure, or an intrauterine device (IUD). This is a normal cellular reaction and is not a sign of precancer or cancer.

Is NILM also used for anal Pap tests?

Yes. The same reporting system used for cervical Pap tests is also applied to anal Pap tests. In this setting, NILM means that no precancerous or cancerous cells were found in a sample taken from the lining of the anal canal. Anal Pap testing is sometimes offered to people at higher risk for anal cancer, including those with a history of human papillomavirus (HPV) infection, HIV, or a weakened immune system. A result of NILM on an anal Pap test is considered normal and reassuring. Your doctor will determine the appropriate follow-up interval based on your individual risk factors.

Is NILM used for other parts of the body?

No. The term NILM applies only to Pap test results from the cervix or the anal canal. Other cell-based laboratory tests — such as urine cytology, fluid cytology, or fine-needle aspiration biopsies — use different reporting systems with their own terminology. NILM is specific to Pap test screening and should not be interpreted using the language of those other tests.

What happens after this result?

Because NILM is a normal result, most people continue with routine cervical cancer screening. How often screening is recommended depends on your age, your HPV test results, and your personal medical history.

In many current guidelines, people who have both a normal Pap test (NILM) and a negative HPV test may be screened every five years. If a Pap test is done without HPV co-testing, screening is often recommended every three years. Guidelines vary by country and are updated as new evidence becomes available. Your doctor is the best source of guidance for your individual screening schedule.

If your report notes additional findings — such as an infection or the presence of endometrial cells — your doctor will advise whether any treatment or further evaluation is needed. These findings do not make the overall Pap test result abnormal.

Questions to ask your doctor

What does NILM mean, and is my Pap test considered normal?
Was my sample adequate for evaluation, and did it include cells from the transformation zone?
Was an HPV test also performed with my Pap test, and what were those results?
Based on my age and medical history, how often should I have a Pap test?
Does my report mention any organisms or other additional findings I should know about?
Do I need any treatment for the additional findings noted on my Pap test?
I am over 45 and normal endometrial cells were noted — do I need any further evaluation?
Should I consider HPV vaccination, and is it recommended for someone my age?
What would happen if my next Pap test showed an abnormal result?
Are there any symptoms I should watch for between Pap tests?
Does my personal or family health history affect how my Pap test results are managed?
At what age is it appropriate for me to stop routine cervical cancer screening?