title: The impact of sputum quality on tuberculosis diagnosis: a systematic review.
abstract: OBJECTIVE
  To perform a systematic review to evaluate the impact of sputum quality on the yield of tuberculosis (TB) diagnostic tests.
  
  
  METHODS
  We searched PubMed, EMBASE, LILACS and the Cochrane Database to identify studies that addressed 1) the impact of sputum quality on the proportion of sputum samples with Mycobacterium tuberculosis detected using smear, culture or polymerase chain reaction (PCR); and 2) the impact of pre-sputum collection interventions on sputum quality and M. tuberculosis detection.
  
  
  RESULTS
  Ten studies met the eligibility criteria for review inclusion. Five studies assessed macroscopic and/or microscopic sputum quality characteristics and M. tuberculosis detection. The other five studies assessed the impact of pre-sputum collection interventions on sputum quality and M. tuberculosis detection. No studies assessed the impact of sputum quality on PCR-based diagnostic tests.
  
  
  CONCLUSIONS
  Definitive conclusions about the utility of sputum quality assessments are limited by the paucity of, and heterogeneity within, the available data. Given the potential for sputum quality assessments to enhance diagnostic yield and prevent wasteful laboratory testing, further research into this field is urgently needed.
authors: South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; The Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.
authors: J
authors: J
authors: Ho
authors: South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; The Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.
authors: G B
authors: GB
authors: Marks
authors: The Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
authors: G J
authors: GJ
authors: Fox
mesh_terms: D015373:Bacterial Typing Techniques; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000379:methods; D011786:Quality Control; D011792:Quebec; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000379:methods*; D013183:Sputum / Q000382:microbiology*; D014376:Tuberculosis / Q000175:diagnosis*
chemical_list: D004269:DNA, Bacterial