Tuberculosis Diagnostic Testing in Korea: Evolution and Future Perspectives

Tuberculosis (TB) remains a major airborne infectious disease, and delayed diagnosis continues to contribute to ongoing transmission.Korea presents a unique epidemiological context, characterized by a relatively high burden of latent infection and reactivation-driven disease despite longstanding national control programs.This review summarizes the historical evolution of TB diagnostic testing in Korea and its clinical implications.Early diagnostic strategies were developed within a government-led public health system, focusing on mass screening by employing chest radiography, acid-fast bacilli smear microscopy, and culture.Since the 1990s, liquid culture systems and polymerase chain reaction (PCR) improved diagnostic speed and sensitivity.In the 2000s, real-time PCR and automated systems enhanced accuracy and enabled differentiation between Mycobacterium tuberculosis and nontuberculous mycobacteria.From the 2010s onward, Xpert MTB/RIF, line probe assays, and next-generation sequencing have shifted the diagnostic paradigm toward early molecular resistance detection.Overall, TB diagnostics in Korea have transitioned from public health-oriented screening to rapid, laboratorybased molecular diagnostics.Understanding this transition provides insight into current diagnostic strategies and supports more integrated and context-specific approaches.