Abstract: Silicon nanowires, as a novel one - dimensional nanosemiconductor material, possess advantages such as ease of modification, compatibility with metal -oxide -semiconductor (MOS) processes, and the potential for mass production. Field-effect transistor (FET) biosensors based on silicon nanowires have garnered significant attention in recent years, particularly in the field of biomedical detection. This is due to their ultra-sensitivity, label-free nature, rapid response, accuracy, and the ability to perform real-time detection of disease-related proteins, nucleic acids, and other target molecules. In light of this, the paper provides a detailed exposition of the working principles of silicon nanowire FET sensors, the methods for modifying probe molecules on various silicon nanowire substrates, and strategies for enhancing the sensing performance of these sensors. This includes methods to overcome Debye screening, selective modification of the sensing region, and sensor signal output modes. The paper also envisions future development directions for silicon nanowire biosensors. It is hoped that this work can offer theoretical insights for the application of silicon nanowire sensors in disease diagnosis.