Electrochemical cell-based biosensors have been showing increasing interest within the last 15 years, with a large number of reports generally dealing with the sensors’ sensitivity, selectivity, stability, signal-to-noise ratio, spatiotemporal resolution, etc. However, only a few of them are now available as commercial products on the market. In this review, technological advances, current challenges and opportunities of electrochemical cell-based biosensors are presented. The article encompasses emerging studies, mainly focusing on the last five years (from 2016 to mid 2021), towards cell-based biological field-effect devices, cell-based impedimetric sensors and cell-based microelectrode arrays. In addition, special attention lies on recent progress in recording at the single-cellular level, including intracellular monitoring with high spatiotemporal resolution as well as integration into microfluidics for lab-on-a-chip applications. Moreover, a comprehensive discussion on challenges and future perspectives will address the future potential of electrochemical cell-based biosensors.