The rapid and precise detection of biomarkers and pathogens remains a critical challenge in clinical diagnostics. Traditional methodologies are frequently hindered by protracted workflows, complex sample preparation, and reliance on resource-intensive instrumentation. Acoustofluidics-the synergistic integration of acoustics and microfluidics-has emerged as a transformative solution for point-of-care testing (POCT). Bulk acoustic wave (BAW) and surface acoustic wave (SAW) technologies enable the contactless, label-free, and biocompatible manipulation of bioparticles across micro- and nanometer scales. This review critically examines recent advancements in BAW- and SAW-based acoustofluidic biosensors. We elucidate the fundamental principles governing distinct acoustic modes-including Quartz Crystal Microbalance (QCM), film bulk acoustic resonator (FBAR), and Solidly Mounted Resonator (SMR) for BAW and Rayleigh and Love waves for SAW-and evaluate their specific roles in liquid-phase sensing, particle sorting, and cellular focusing. Results show that integrating on-chip sample preparation accelerates diagnostic workflows, reducing assay times to under 10 min. Coupling acoustic manipulation with optical, mass-based, or electrochemical modalities effectively overcomes fundamental diffusion limits, achieving ultrasensitive, multimodal detection. We address translational challenges-acoustothermal heating, biofouling, and scalable integration. Following a discussion of clinical applications in oncology and infectious diseases, we map emerging trajectories, emphasizing AI-driven intelligent microfluidics, modular architectures, and flexible wearable platforms that will ultimately democratize continuous precision diagnostics.
Keywords: acoustofluidic; biomarker; biosensors; point-of-care; surface acoustic wave.