Revolutionizing medical image analysis, the Segment Anything Model (SAM) stands out among emerging foundation models, yet its potential in accurately segmenting small, irregular ROIs from multi-center, diverse datasets remains untapped in real-world scenarios. Our study harnesses SAM’s capabilities to address the segmentation intricacies of clinically crucial, yet challenging, features in complex medical imaging. To bridge this gap, we embark on a comprehensive exploration anchored in Foundation models including SegVol and MedSAM, targeting three pivotal challenges: 1) enhancing the generalization of models across diverse medical image modalities and sequences, 2) reinforcing the stability of interactive segmentation, and 3) overcoming the segmentation hurdles posed by minuscule, atypical ROIs. We employ a coarse-to-fine segmentation strategy, using the CARE24 dataset alongside a meticulously publicly available dataset to fine-tune these models for enhanced real-world performance. To boost the stability and precision of interactive segmentation, we devise a retest mechanism, ensuring consistent outcomes in user-guided processes. Furthermore, recognizing the potential of multimodal data, we introduce a fusion strategy, capitalizing on complementary information to improve overall segmentation accuracy and adaptability.