PURPOSE Comprehensive genomic profiling (CGP) of sarcomas is rapidly being integrated into routine clinical care to help refine diagnosis and prognosis and determine treatment. However, little is known about barriers to successful CGP or its clinical utility in sarcoma. We set out to determine whether CGP alters physician treatment decision-making, and whether sarcoma subtypes influence the frequency of successful technical performance of CGP. METHODS A single-institution study evaluated profiling outcomes of 392 samples from patients with sarcoma, using a commercially available CGP panel. Of this group, 34 patients were evaluated prospectively (Decision Impact Trial) to evaluate the utility of CGP in physician decision-making. All cases were retrospectively analyzed to identify causes of CGP failure. RESULTS CGP successfully interrogated 75.3% (n = 295 of 392) of patients with sarcoma. Bone sarcomas had lower passing rates at 65.3% (n = 32 of 49) compared with soft tissue sarcomas at 76.7% (n = 263 of 343; P = .0008). Biopsy location also correlated with profiling efficiency. Bone biopsy specimens had a 52.8% (n = 19 of 36) passing rate versus lung (61.1%; n = 33 of 54) and abdomen (80.1%; n = 109 of 136) specimens. CGP altered physician treatment selection in 25% of evaluable patients (n = 7 of 28) and was associated with improved progression-free survival. CONCLUSION To our knowledge, this is the largest technical evaluation of the performance of CGP in sarcoma. CGP was effectively performed in the vast majority of sarcoma samples and altered physician treatment selection. Tumor location and tissue subtype were key determinants of profiling success and associated with preanalytic variables that affect DNA and RNA quality. These results support standardized biopsy collection protocols to improve profiling outcomes.

N THIS paper the author ventures to raise the question of psychic con-I stitution in childhood by a brief description of what seem to be two very different types of emotional make-up, apparently innate and not caused by factors in the environment.Adlerian, Jungian, and general psychiatric terminology have been avoided as unsuited to a non-medical child psychotherapist whose contentions are based chiefly on a long clinical experience of difficult children and much observation of human beings in general. I t is, therefore, proposed to use the words "externalized" and "internalized" for the two categories. Only one kind of externalized psyche, that of the power-seeking child, can be considered here, though others such as the dramatizing and the hyper-active varieties also appear to exist.The importance of recognising psychic constitution will be stressed so that nurture can rectify and not accentuate undesirable behaviour patterns which often seem inherent in a child's emotional nature. EXTERNALIZED, POWER-SEEKING CHILDRENThe outstanding traits of such children seem to be: 1) A rich endowment of emotion expressed in vehement and impetuous demonstrations of aggression, fear, love, and various forms of sensuous enjoyment, such as thumb-sucking, masturbation, etc. 2) The psychic energy appears to be located on the surface of the child's body, and orientated toward the environment which is always expected to enhance or menace his ego. The ego seems to become clearly defined and differentiated at age 23 or earlier. Acute awareness as a ' discrete personality usually persists throughout life and causes him to be regarded as extremely egocentric. In other words, there is an inherent attraction to the conscious, particularly to self-consciousness, which is soon discovered to be separated from yet linked to his surroundings in a relationship that is usually envisaged as one of superiority or of inferiority. 3) Such children have an urge or craving to dominate people and situations which cannot be fully understood if regarded solely as a defence mechanism. The existence of what Seem to be deeply rooted patterns distinguishes this kind of child from other psychically externalized children. Cynthia X, aged 7, a well-developed, healthy, vital-looking child, was said to be extremely difficult at home unless she could dominate and arrange * Child psycho-therapist and social worker.The original English spelling has been retained in this article.

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