Background: There are controversies regarding the use of the interferon-γ release assay (IGRA) or tuberculin skin test (TST) for the detection of latent tuberculosis infection (LTBI). We assessed three factors relevant to the detection of LTBI: predictive value of progression to active TB, target value of preventive treatment, and the necessity of combination of IGRA and TST. Methods: We searched PubMed, EMBASE, Web of Science, and the Cochrane Library for relevant studies until April 2019. We calculated the risk ratio (RR) for the rates of disease progression in persons with positive versus negative test to assess the predictive value. We calculated the positive predictive value (PPV) and RR for the rates of disease progression in untreated versus treated persons of the positive test to assess the target value of preventive treatment. We calculated the proportion of disease progression in the combination groups and RR for rates of disease progression in untreated versus treated persons to assess the necessity of combination. Findings: A total of 31 relevant studies including 46775 persons were included in the final analysis. The strength of the association between IGRA+ results, as well as TST+, and development of active TB was high. However, IGRA+ was higher than TST+. The PPV of IGRA+ persons was higher than TST+, and the PPV of QuantiFERON®-TB (QFT) was the highest. The association between untreated and development with QFT+ was strong, unlike that of other single tests. The proportion of progressed IGRA+/TST+ persons was the highest in the combination tests. Moreover, the proportion of progressed persons in the IGRA+/TST− group was significantly higher than that observed in the IGRA−/TST+ and IGRA−/TST− groups. The association between untreated and development with IGRA+/TST+ group was stronger than that of any other single use group. Interpretation: Both IGRA and TST can predict the subsequent development of active TB; however, IGRA is more reliable than TST. IGRA is more accurate for targeting preventive treatment and offers more benefit from treatment than TST. Furthermore, QFT is a optimal recommendation for single use, and the combination of IGRA and TST is unnecessary. Funding Statement: National Natural Science Foundation of China (grant numbers 81860644, 81560596, and 31560051), and Natural Foundation of Yunnan Province (grant numbers 2017FE467-001 and 2014FA011).Declaration of Interests: The authors declare no potential conflicts of interest.